Provider Demographics
NPI:1780711176
Name:GRIECO, WILLIAM ANDREW
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ANDREW
Last Name:GRIECO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROSEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-5523
Mailing Address - Country:US
Mailing Address - Phone:617-538-3518
Mailing Address - Fax:781-849-2044
Practice Address - Street 1:1 ROSEDALE AVE
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-5523
Practice Address - Country:US
Practice Address - Phone:617-538-3518
Practice Address - Fax:781-849-2044
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS72449246343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1712675Medicaid